ARV Treatment: Special Focus
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When I decided to join this meeting I was already convinced that it is currently not cost-effective for most governments of less developed countries (LDC) especially in sub-Saharan Africa to provide publicly funded ARV to treat PWAs in their countries. My expectation in attending this forum was to see if there are any creative and "revolutionary" ideas on how this unacceptable situation can be changed. Cost-effectiveness studies are important and must continue to be used to help in our choice of programs and priorities. However, I would like also to suggest that it is crucial that we make efforts to go beyond cost-effectiveness. Studies must be undertaken to identify means and ways that resources can be mobilized within and out of LDC to respond to the needs of PWAs. These studies must avoid putting all LDC in one single bag as they are diverse and the response may be different from one country to another. For some countries there may be just a need to better use and allocate existing resources, whereas for others resources may have to be raised using various strategies (e.g. special taxes on some goods such as alcohol, tobacco), and yet for others international aid will still be needed at different levels. HIV/AIDS is here and will be around for a while. How long will we continue to tell those sufffering and dying in LDC that they can't get treatments they know exist just because they have the misfortune of being born and living in the wrong part of the world? Among many things that the HIV/AIDS epidemic has taught us is the fact that nothing must be considered unchangeable. it takes strong will, courage, creativity, and perseverance to change what may seem impossible today. We are told again and again how LDC health budgets are limited and would become bankrupt if ARV treatment were publicly funded. However, we know that in the 80s when the HIV/AIDS epidemic was just starting to be recognized by some LDC, at the same time a number of poorest countries had to reduce their health budgets by half, "forced" by structural adjustment to reduce their foreign debt. We know also that it has been suggested that it would take only 10% of the International Monetary Fund's gold stocks to write off foreign debt accross Africa (Oxfam Campaigner Nov. 1994). can we think about starting with 0.5% of the IMF's stocks toward a more equitable distribution of resources? People are suffering and dying and something must be done. Our question must not remain "can the treatment be made available or not?". Rather, it must be "HOW CAN THE TREATMENT BE MADE AVAILABLE?". To challenge our economist colleagues, I would like to end my intervention with this quote from a presentation by Kenneth Boulding in 1959:"...the economist has a certain conservative bias, and that his warnings against crying for the moon may prevent us landing on it". |
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